Gout (Gouty Arthritis) (cont.)

Catherine Burt Driver, MD

Catherine Burt Driver, MD, is board certified in internal medicine and rheumatology by the American Board of Internal Medicine. Dr. Driver is a member of the American College of Rheumatology. She currently is in active practice in the field of rheumatology in Mission Viejo, Calif., where she is a partner in Mission Internal Medical Group.

William C. Shiel Jr., MD, FACP, FACR

Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.

What are risk factors for gout?

There are many risk factors for gout. Gout is more common after surgery, trauma, and dehydration. Certain medications such as diuretics (commonly known as water pills) that raise the level of uric acid in the bloodstream are risks for gout. Surprisingly, medications that lower the level of uric acid in the bloodstream, such as allopurinol (Zyloprim, Aloprim), can also initially cause a flare of gout. This is because anything that raises or lowers the uric acid level can cause a gout flare by causing uric acid crystals to deposit in a joint. Low-dose aspirin may precipitate gout attacks. The treatment of certain types of cancer can cause gout because of high levels of uric acid released when cells are destroyed. Degenerative arthritis also makes affected joints more likely to be the site of a gouty attack.

What are gout symptoms and signs?

The characteristic symptoms and signs of gout are

sudden onset of joint pain,

joint swelling,

heat in the affected area,

joint redness.

This usually affects a single joint. The pain is typically severe, reflecting the severity of inflammation in the joint. The affected joint is often very sensitive to touch to the point that some people with gout attacks experience pain from something as simple as pulling the bedsheets over the affected area.

Gout frequently affects joints in the lower extremities. The most typical location for gout to occur is the big toe. Podagra is the medical term for a gout attack in the big toe. Gout can also affect the foot, knee, ankle, elbow, wrist, hands, or nearly any joint in the body. When gout is more severe or longstanding, multiple joints may be affected at the same time.

Another sign of gout is the presence of tophi. A tophus is a hard nodule of uric acid that deposits under the skin. Tophi can be found in various locations in the body, commonly on the elbows, upper ear cartilage, and on the surface of other joints. When a tophus is present, it indicates that the body is significantly overloaded with uric acid. When tophi are present, the uric acid level in the bloodstream has been high for years. The presence of tophi indicates tophaceous gout, and treatment with medications is necessary.

Kidney stones may be a sign of gout as uric acid crystals can deposit in the kidney and cause kidney stones.